The AIDS epidemic disproportionately affects women of color who are marginalized socially, economically, and politically. Women with severe mental illness (SMI) in urban city settings represent a high risk group with these demographics, but are further challenged by stigma in addition to cognitive impairment and frequently, psychiatric symptoms related to their mental illness. Established methods of HIV prevention have not curtailed the AIDS epidemic among these women. During the award period the applicant aims to explore social contextual factors that increase risk for these women, and to develop new options for individual risk reduction given these day to day realities. The specific aims of the study are to 1) To assess--quantitatively and qualitatively--the impact of the stigma of mental illness on sexual risk behavior among women with SMI in the United States. 2) To use the results of Aim 1 to refine and further develop the curriculum of HIV prevention in this population. 3) To test the modified intervention for efficacy in a randomized clinical trial of 120 women (N=60 experimental; N=60 controlled) recruited from the outpatient psychiatric clinics of the New York State Psychiatric Institute. The proposed training plan will enable the applicant to contribute to prevention of the HIV among disadvantaged, culturally diverse women with severe mental illness. The applicant's broad goals are 1) to gain a clear understanding of how complex social factors--stigma, poverty, racism, violence, gender inequality--constrain the sexual choices of women, putting them at risk for AIDS, unwanted pregnancies, and STDs; and 2) to amass the skills necessary for developing HIV preventative interventions that are contextually appropriate and relevant for disadvantaged women around the world. The career development award would enable the applicant to receive formal training in the following areas: 1) formal course work in anthropology, sociology, as well as epidemiology in order to master methodologies for assessing contextual needs, developing interventions and testing their effects in the target populations. 2) develop expertise at integrating culture, context, and gender-specific variables into interventions for women with mental illness. 3) become knowledgeable in research design and complete pilot work for a randomized clinical trial testing the HIV preventative intervention developed by the applicant.